Incidence and predictive factors of problems after fixation of trochanteric hip fractures with sliding hip screw or intramedullary devices

Piers Page, M Field, N Vetharajan, A Smith, L Duggleby, Dario Cazzola, Michael Whitehouse, Richie Gill

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Abstract

Introduction
Hip fractures are common and disabling injuries, affecting mainly older adults. Due to the morbidity associated with non-operative management, most are managed surgically. Trochanteric fractures are generally fixed with a sliding hip screw or an intramedullary nail. Data is available in the National Hip Fracture Database to quantify early failures of fixation, amongst other major complications, but late or less overt complications may not be recorded. This study sought to quantify and describe problems arising after fixation and from this information identify predictors of such problems.

Methods
Patients with a trochanteric fracture were identified from the NHFD over a three-year period from three different sites. From this cohort, any patients with further related episodes of care were identified and reasons recorded. These patients were then age- and sex-matched with those with no identifiable related episodes of care. Data was collected on Arbeitsgemeinschaft für Osteosynthesefragen classification, tip-apex distance, American Society of Anesthesiologists grade, Abbreviated Mental Test Score and pre-injury mobility levels. A binomial logistic regression model used to identify predictors of problems.

Results
A total of 4010 patients were entered in the NHFD across three sites between January 2013 and December 2015. Of these, 1260 had sustained trochanteric fractures and 57 (4.5%) subsequently experienced problems that led to them re-presenting to a hip surgeon. The most common problem was failure of fixation, occurring in 22 patients (1.7%). The binomial logistic regression model explained 47.6% of the variance in incidence of problems. Two variables, ASA grade and tip-apex distance were predictive of problems.

Discussion
The incidence of re-presentation with problems following fixation of trochanteric hip fractures is in the region of 5%. A failure rate of less than 2% was seen, in keeping with existing data. Crucially, whether an intramedullary nail or sliding hip screw was used was not predictive and patients with both classes of device experienced problems. We have shown that fixation of hip fractures continues to yield imperfect results, and that the health state of the patient and adherence to basic surgical principles may prove the most important factors driving a good outcome.
Original languageEnglish
JournalHip International
Early online date14 Sep 2020
DOIs
Publication statusE-pub ahead of print - 14 Sep 2020

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